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The national cataracts programme has helped to reduce maximum waiting times for cataract operations to just three months, which is four years ahead of the original target in the NHS plan. The Department of Health has only recently launched a toolkit to help primary care trusts commission a greater range of community-based eye care services to improve patient convenience and choice. However, we need to ensure that we continue to support the NHS in delivering
improved eye care services for patients in line with the improvements that medical technology and science allow.
I fully understand that there is a great deal of interest in this area, with the development of new treatments potentially offering hope to more patients than it has been possible to treat in the past. As the right hon. Gentleman said, there are two main types of macular degeneration, usually referred to as dry AMD and wet AMD. The dry type of AMD is the more common form. The onset of this condition tends to be slow, with the vision deteriorating gradually. People are often not aware of the loss of vision, if initially only one eye is affected, and these cases are often picked up at an eye examination carried out by an optometrist as part of an NHS sight test.
It remains a sobering fact that dry AMD is not treatable. However, there is a great deal that can be done to support people with visual impairment, partly through vision aids but also through rehabilitation and training services. In that context the effective collaboration of relevant agencies across health, social care and the voluntary sector is vital.
Our debate focuses on the other type of macular degeneration, known as wet AMD. It is less common but tends to be more severe, with a rapid effect on the central area of vision. Blood vessels form under the retina at the back of the eye and may leak, causing a rapid and significant reduction in central vision. In 2003, the National Institute for Health and Clinical Excellence recommended the use of photodynamic therapy for treating wet age-related macular degeneration in some patients. All PCTs are now funding photodynamic therapy in accordance with NICEs guidance. That is an important point of context for this debateNICE has already recommended a treatment that all PCTs are funding.
However, NICE is currently appraising two drug treatments that have been developed, Macugen and Lucentis. The new treatments offer the scope to treat a greater range of patients than with photodynamic therapy. NICE is expected to publish guidance on Macugen and Lucentis this October, following a public consultation on draft guidance in the summer.
I stress to the right hon. Gentleman that NICE plays an important role in appraising those and other new treatments. He claimed that the Department had opted out of the process and simply left the decision to the 152 primary care trusts. The NICE process invests in that independent body the capacity to advise the national health service about new treatments, and I think that he and others would be the first to complain if the Department intervened on every similar issue to take decisions based on levels of public concern or anxiety. It must be a clinical decision. It is also right that it is a clinical decision at local level whether funding is made available for NICE.
I am sure that the right hon. Gentleman would accept that the NICE process is incredibly thorough and detailed. Because of that, it inevitably takes some time to complete. NICE has
developed a reputation around the world for producing the gold standard of advice on new drugs and technologies, such is the quality of its work.
I refer again to my guidance to the national health service on 14 December last year on precisely what happens in the interim when a treatment is being considered by NICE. I say categorically for the record that it is not appropriate for PCTs to refuse treatment simply on the basis that NICE guidance has not yet been issued. I cannot be any clearer than that. Neither is it appropriate for such decisions to be taken in Whitehall, bypassing the system established to ensure that national clinical guidance is of the highest quality and based on a robust and independent assessment of the evidence, which is exactly what is happening at the moment. I fully appreciate peoples frustrations as that process takes its time, but I repeat what the Secretary of State said a few weeks ago: no PCT should deny patients Lucentis or Macugen on the basis that NICE has not yet finalised its deliberations.
John Penrose: I appreciate what the Minister says about the guidance that he issued. Does he have any evidence either way that it is actually being followed? Anecdotallyaround the country and, I suspect, in many hon. Members surgeriesthere is abundant comment from patients and others that decisions are being taken locally on the basis of finance. The decisions have to be taken on that basis because the money is not there to pay for this stuff. I am concerned that the Ministers guidelines may, generally, not be being followed as he thinks they are.
Andy Burnham: It is for PCTs to determine those questions. In many cases they will set clinical criteria, whereby cases will be considered on an exceptional basis and a clinically led decision will be taken locally. That is the right way for them to proceed. Opposition Members often say, Trust the professionals. Trust the NHS. Dont interfere in all the decisions that the system makes. At the same time, however, we get another request to do differently. In this case, the guidance from the centre could not be clearer: PCTs should consider the best available international evidence, and other clinical evidence, available today on those treatments and make their decisions on the back of that. However, like all health commissioners, they have to balance available resources with the clinical evidence. That is the job that NICE has to do, too.
I want to take up some of the particular cases picked up in the debate. The right hon. Member for North-West Hampshire mentioned Bristol, but he was incorrect. I understand that Bristol teaching primary care trust has not advised consultants that its patients
cannot apply through the exceptional funding panels for funding for this treatment. All cases will be considered on individual merit. In such cases it is crucial to be precise with the information, because this matters a great deal to people in those areas and it is important that that clarification is put on the record.
The hon. Member for North Norfolk (Norman Lamb) mentioned two cases in his constituency. Like anybody, I could not help being moved by the instance that he put forward. Norfolk primary care trust will be reviewing its policy on funding treatments for AMD in May and a decision will be taken at the board meeting on 22 May. I think that the hon. Gentleman said that Norfolk and Norwich University Hospital NHS Trust has put a specific proposal to the PCT about Avastin and a different way of doing things. Again, those decisions are to be taken locally. It is not for me to intervene in those decisions. I hope that the hon. Gentleman feels that there is some comfort in that time scale and that these issues are being addressed quite speedily.
The right hon. Member for North-West Hampshire mentioned Mrs. Beeby from Southampton. I am advised that until recently there was no formal process for managing the authorisation and treatment of patients with Lucentis or Macugen within Hampshire PCT and, as there was no clear procedure, the consultant at Southampton eye clinic was not able to correctly refer the patient in question. However, the PCT identified that problem. It recently met Southampton University Hospitals NHS Trust and agreed a process for managing the authorisation and treatment of patients on a case-by-case basis. There should now be no barriers to cases being advanced for consideration by clinicians.
The right hon. Gentleman mentioned the head-to-head trial, which is important and is, perhaps, an area where we can find some good measure of agreement. He asked about progress. I am pleased to advise that the National Institute for Health Research health technology assessment programme has agreed to fund a head-to-head trial of Avastin and Lucentis over a 42-month period. We hope that the project will start on 1 May 2007. The right hon. Gentleman made an interesting suggestion about whether people could be referred to that trial from different parts of the country. I can tell him that contracts are yet to be signed. Details will follow about whether that is possible. However, the Department will feed that proposal into the process. It would be too early for me to promise anything, but it is a point well made. I will take that away and I will, if I may, come back to him in due course.